INTERNATIONAL SYMPOSIUM LAPAN-IPB SATELLITE 2014

(LISAT SYMPOSIUM 2014)

25-26 November 2014

REGISTRATION FORM
Name of participant: (Check one) Prof. Dr. Mr. Ms.
______________________________________________________________________________
Institution:
______________________________________________________________________________
Contact Information:
Street:_______________________________________________________________________
City:_________________________________________________________________________
State/Province: ______________________________________ Postal Code: __________
Country:_____________________________________________________________________
Phone: ________________________________ Fax: _________________________________
E-mail:_______________________________________________________________________
Topic on paralel session: (Check one)
Agriculture Marine and Fisheries Climate
Technology

Forest

Satellite

Participation Type: (Check one)

Oral Presentation Poster Presentation Non paper participant
Payment for Registration:
Bank Details:
Account Name:
Account Number:
Please fax or e-mail this form to:
Organizing Committee LISAT Symposium 2014
PPLH-LPPM, IPB
Jalan Lingkar Akademik. Kampus IPB Darmaga. Bogor 16680. Indonesia
Phone: +62 (251) 8621262, 8621085; Fax: +62 (251) 8621134
E-mail: symposiumlisat@apps.ipb.ac.id